P.O. Box 934, Olney, MD 20830
[email protected]
www.projectchange-md.org
301-257-4769
2015 STUDENT LEADERSHIP INSTITUTE
Rising Sixth through Eighth Graders
Session 1 - July 13-17
Session 2 - July 20-24
St. John’s Episcopal School, 3427 Olney Laytonsville Road, Olney, MD 20832
Student’s Name ________________________________________________________
Address ______________________________________________________________
______________________________________________________________
Parent/Guardian’s Name__________________________________________________
Phone_________________________________________________________________
Email _________________________________________________________________
School student will be attending fall 2015 ____________________________________
Grade in fall 2015 _______
Male _____ Female _____
How many Student Service Learning (SSL) hours has student completed? __________
Has student previously attended the Student Leadership Institute? ___________
Student is registering for (select one): Session 1 (July 13-17) ______ Session 2 (July 20-24) ______
Application Deadline: June 17
Fee: $125 if submitted by May 31; $150 if submitted between June 1 and June 17. Pay online:
www.projectchange-md.org. Go to “Donate” page and click on Student Leadership Institute in down menu.
Pay by mail: Enclose a check payable to “Project Change” and mail to: P.O. Box 934, Olney, MD 20830.
Please check box
if you request limited need-based (50%) scholarship funds. First come first served
basis. Submit application without payment. Project Change will contact you.